Post-combat syndromes from the Boer war to the Gulf war: a cluster analysis of their nature and attribution.

OBJECTIVES To discover whether post-combat syndromes have existed after modern wars and what relation they bear to each other. DESIGN Review of medical and military records of servicemen and cluster analysis of symptoms. DATA SOURCES Records for 1856 veterans randomly selected from war pension files awarded from 1872 and from the Medical Assessment Programme for Gulf war veterans. MAIN OUTCOME MEASURES Characteristic patterns of symptom clusters and their relation to dependent variables including war, diagnosis, predisposing physical illness, and exposure to combat; and servicemen's changing attributions for post-combat disorders. RESULTS Three varieties of post-combat disorder were identified-a debility syndrome (associated with the 19th and early 20th centuries), somatic syndrome (related primarily to the first world war), and a neuropsychiatric syndrome (associated with the second world war and the Gulf conflict). The era in which the war occurred was overwhelmingly the best predictor of cluster membership. CONCLUSIONS All modern wars have been associated with a syndrome characterised by unexplained medical symptoms. The form that these assume, the terms used to describe them, and the explanations offered by servicemen and doctors seem to be influenced by advances in medical science, changes in the nature of warfare, and underlying cultural forces.